Introduction
UNAIDS 2010 defined HIV counselling as a confidential dialogue between a client and a counsellor aimed at enabling the client to cope with stress and take personal decisions related to HIV/AIDS.
UNAIDS further stated that the counselling process includes evaluating the personal risk of transmission and discussing how to prevent infection. It concentrates specifically on emotional and social issues related to possible or actual infection with HIV and to AIDS. With the consent of the client, counselling can be extended to spouses, sex partners and relatives (family level counselling based on the concept of shared confidentiality). HIV counselling has its objective both preventive and care. A counsellor is a person trained in the skills of the job, listening to the client, asking supportive question, giving practical information and suggesting follow-up. Counselling is a process involving a series of session as well as follow – up. It can be done in any location that offers peace of mind and confidentiality for the client.
HIV counselling and testing is the gateway/entry point to the HIV/AIDS treatment, care and support. It is composed of two types of testing: VCT–voluntary counselling and testing and PIHCT – provider initiated HIV counselling and testing. HIV counselling and testing enables client/patients to know their status and make informed decisions, it helps to reduce stigma and discrimination and it help to increase access to HIV/AIDS treatments, care and support services (referral).
National Agency for the Control of AIDS (NACA) (2010) states that HCT is done in the three district components, pre–test counselling before the blood is taken and this is meant to prepare the individual for the test and assess the risk level to HIV virus the person possessed. Also, it helps one to anticipate the result, whether it turns out HIV positive or negative. The second component is the taking of blood sample and test by using rapid test kits and lastly is disclosure of result, counselling and referrals, depending on the outcome of the result. NACA also stated that HCT is an integral part of HIV/AIDS. Without HCT, diagnosing HIV may not be possible except when an individual comes down seriously with some of the know symptoms of the disease.
The goals of HIV/AIDS counselling are to:
- Support non-risk behaviour in those who are infected so that they do not transmit the disease to others.
- To protect others who are not infected from risk that exposes them to the disease
- To give and maintain emotional, physical, health and social support to the infected and those who care for them.
- To encourage change when change is needed for prevention or control of infection and
- To provide support in times of crisis
Concept of HIV
According to Iyanwura and Oloyede (2011), HIV counselling is referred to as an interactive section on HIV/AIDS anchored by qualified professionals usually before an HIV test is carried out. They identified counselling in HIV/AIDS as a core element in a holistic model of health care, in which psychological issues are recognized as integral to patient management. Aniebue and Aniebue (2011) stated that HIV/AIDS counselling is geared towards the prevention of HIV transmission and support of those affected directly and indirectly by HIV. In their opinion, it is vital that HIV counselling should have these dual aims because the spread of HIV can be prevented by changes in behaviour resulting from an effective counselling section. Daniyam and Agada (2010) are of the option that one to one prevention counselling enables frank discussion of sensitive aspects of a patient’s life which may be hampered in other settings by the patients concern for confidentiality or anxiety about a judgmental response. They also stated that when patients know that they are HIV positive, they may suffer great psychosocial and psychological stresses through a fear of rejection, social stigma, disease progression, and the uncertainties associated with future management of HIV.
They further stated that good clinical management requires that such issues be managed with consistency and professionalism and counselling can both minimize morbidity and reduce its occurrence. Based on this, Abebe (2014) suggested that all counsellors should have formal counselling training and receive regular clinical supervision as part of adherence to good standards of clinical practice.
Subudde and Nangedo (2013) stated that before HIV testing, one–on–one talk with the counsellors about the expectations of the patient concerning the tests, whether they think they are positive or negative and what they plan on doing in both situations helps the counsellors to have a free knowledge on the perception of the patient and how to effectively manage the outcome of the test result. After that the counsellor observes the clients and their training gives them proper knowledge about how to tell with everyone’s different types of coping.
After being diagnosed with HIV persons can be referred to a clinic where they are counselled and started on ante-retroviral (ARVs) drug if they qualify.
Types of HIV/AIDS counselling
HIV/AIDS counselling comes in different forms depending on the situation and the person being counselled. Some of the types of HIV/AIDS counselling includes:
- Pretest counselling
- Post test counselling
- Treatment adherence counselling
- Ongoing counselling for people affected by HIV.
Pretest counselling
Pretest counselling is a confidential dialogue that will enable an individual to make an informed choice about being tested for HIV. According to World Health Organization (WHO 2012), this decision must be left entirely to the individual and must be free of coercion. To make an informed choice about testing, an individual needs to consider the potential benefits and risk associated with testing. His or her personal risk history must be considered. They further stated that the counsellor supports the clients in managing the potential risk and difficulties by considering the possible psychosocial, legal and health implications of knowing the clients serostatus. The counsellors also assesses the client’s capacity to cope with the possibility of a positive HIV antibody test, provides information on HIV and engages in prevention counselling mainly to reduce transmission risk behaviour and thereby reduces the risk of HIV transmission.
Aniebue and Aniebue (2011) stated that while individual one on one counselling offers the best standard of support to clients, alternative models of providing pre–HIV test information are also available pre-HIV test counselling may be offered to couples. They also stated that in some situations where there are many clients or where the HIV test is offered as part of provide initiated testing and counselling (PIHCT) and opportunities for one on one counselling are limited (because of time or human resource constraints) group pre-test information may be offered. Information can be given in a group, but the informed consent component must always take place in a one on one setting to ensure that the patient’s choice is autonomous and not coerced.
Post test counselling
Ikechebelu, Udighe and Imoh (2014), stated that post-HIV test counselling is done primarily to ensure that individual understand the meaning and implications of their test result. If the clients test positive for HIV antibodies, post – test counselling must make it easier for him or her to adapt to life with HIV and STI infection. Ikechebelu et al. (2014) stated that post – HIV test counselling is typically provided by the counsellor who conducted the pretest counselling because of the established relationship between the client and counsellors which provides a sense of continuity for the clients and the counsellor will also have a better idea of how to approach the post-test counselling because of what he or she experienced in the pretest counselling.
According to Daniyan and Agada (2010), post test counselling will depend on the outcome of the test – which may be negative results, a positive result or an inconclusive result. They also stated that post test counselling enables the client to accept their result as it appears and helps them to face their fear. In case of a positive result, post test counselling is to ensure that the person has support and somebody with whom to share the burden. Ikechebelu et al. (2014) stated that the counsellor providing the post test counselling should be sensitive to the possibility of suicide. If client shows any suicidal tendencies, emergency hospitalization should be arranged as suicide presents significant challenges to counsellor.
Treatment adherence counselling
Wusu and Okokoni (2011) stated that adherence counselling focuses on the whole process from choosing, starting, managing to maintaining a given therapeutic medication regimen to control HIV viral replication and function of the immune system. The significance of adherence to treatment has become recognized, which is important in optimizing the patient’s response to therapy.
Oshi, Ezugwu, Dimkpa, Korie and Okperi (2013) stated that effective counselling assist patients to adhere to HIV management procedure by encouraging patient to take drugs according to specifications. Wusu and Okokoni (2011) identified the fact that HIV patients are confronted with many difficulties when required to take medication whereas the role of the counsellor is to help the patients deal with the many psychological, physical and practical barriers to treatment adherence. Aniebue and Aniebue (2011) stated that adherence counselling is a four-stage approach that incorporates principles of learning theory, the daily living challenges of the patient and the complexity of medical and psychosocial factors specific to HIV practice. They also stated that the s should be able to carry the patient effectively though the four stages which include a) general preparation, b) treatment initiation, c) consolidation and d) maintenance.
According to Wusu and Okokoni (2011) adherence counselling provided during treatment helps to improve the patient’s knowledge of both the disease and the medication and their side effects. Counselling helps the patient set goals, develops positive beliefs and perception and increase self efficacy in maintaining treatment.
Ongoing counselling for people affected by HIV
According to Onyeonoro (2011) the chronic and progressive natural history of the HIV infection means that the psychosocial issues confronting both infected and affected individual changes throughout the course of the illness and at such, counsellors should be able to detect these changes and assists the patient to go through them with effective counselling. Onyeonoro further stated that ongoing counselling provides opportunities for psychological issues affecting the patient to be recognized and managed with the help of the counsellors. He stated that for many, becoming infected with HIV reactivates previously unresolved issues such as acceptance of sexual orientation, specific traumatic events such as sexual assault or unresolved relationship problems and at such infected and affected persons may also need practical assistance such as referral to welfare services, liaison with caregivers, the preparation of wills and the organization of substitute care for children to ease the burden which they may encounter and enable them to go through these stages.
Importance of HIV/AIDS counselling
Federal Ministry of Health (FMOH) 2012) stated that from the minute a person decides to take the HIV test, a counsellor’s role begins. They also stated that counselling is important before, during and after test are done by stressing that counselling helps patients accept their status. Abebe (2014) stated that counselling is a core element in the management of HIV/AIDS patient and its importance cannot be over emphasized. He also stated that counselling is important in providing support and eliciting behaviour change in HIV patients. He outlined the following as some of the importance of counselling.
- Determining whether the lifestyle of an individual places him or her at risk
- Helps to reduce psychological morbidity associated with HIV infection.
- Working with the individual to achieve and sustain behaviour change.
- Helping the individual to define the true potential for behaviour change.
- Helping to identify the meanings of high risk behaviour.
Problems of HIV/AIDS counselling in Nigeria
According to World Health Organization (WHO) (2014), in Nigeria there are several factors that may limit what the counsellors can do. This include ethical, legal, psychological and social issues that are challenging and at times frustrating to the counsellor involved in HIV/AIDS counselling. There are fundamental problems in ensuring privacy and confidentiality.
Iyaniwura and Oloyede (2011) stated that the Nigerian culture accepts that everyone in the neighbourhood takes an interest in what is happening in the lives of their neighbours. As positive as this may be at other times, it has a hindrance in counselling patients with HIV/AIDS. The problem is that the counsellor may be inhibited in visiting clients at home to avoid bringing upon them suspicion and the associated stigma, possible ridicule and even possible homicide by non-supportive family members who may see the client as disgrace. Onyeonoro (2011) noted that while the few people working in this area may still be able to help through anonymous counselling, they lack facilities and resources to do this most of the time. National Agency for the Control of AIDS (NACA) (2010) stated that it is uncertain whether appropriate and adequate counselling is provided though screening facilities provided by the government. Some people go without counselling before and after screening, except for the general health information that health practitioners give. Many health practitioners are as ignorant and as afraid as members of the general public, if not more so. The general pretence that anyone can do counselling and the poor attention given to the need to train people for the job may prove to be expensive for the country in the long run. Daniyam and Agaba (2010) identified an acute problem of non availability of trained counsellors to handle most of the sensitive issue that often arise, to help the untrained persons who are forced to take responsibility and to give the time required to meet the needs of the people affected. Making use of any untrained available person to do HIV/AIDS counselling may be doing more harm than good.
Measures to promote effective HIV/AIDS counselling
To ensure adequate and effective HIV counselling, the following measures were suggested by Ikechebelu et al. (2014).
- Counselling should be a fundamental right of the client in healthcare, irrespective of the nature of the disease or health needs that bring the client in contact with the system.
- There is a need to see how this old phenomenon of kinship can be improved upon to help the family cope with the virus.
- It is necessary for health practitioners to build scheduled counselling sessions into care regimes for all clients.
- As a matter of urgency, there is a need for anonymous counselling facilities. These for a start could be in the big cities and towns and possibly linked to all health units.
- The government, philanthropic organizations and individuals should help existing counselling groups to train more people to expand the scope of coverage to reach many more people affected, not only by HIV or AIDS but by other terminal disease.
References
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